Monday, May 27, 2024

U.S. Attorney Announces $10.1 Million Settlement With Managed Long-Term Care Plan For Improper Receipt Of Medicaid Payments

 

RiverSpring Admits That It Failed to Provide Required Services, or Failed to Adequately Document the Provision of Services, to Members of Its Managed Long-Term Care Plan      

Damian Williams, the United States Attorney for the Southern District of New York, and Naomi Gruchacz, the Special Agent in Charge of the New York Regional Office of the U.S. Department of Health and Human Services, Office of Inspector General (“HHS-OIG”), announced a settlement of a civil fraud lawsuit against RIVERSPRING LIVING HOLDING CORP. and ELDERSERVE HEALTH, INC., d/b/a RiverSpring at Home (“RIVERSPRING”), New York not-for-profit corporations that, among other things, administer a Managed Long Term Care Plan (the “RiverSpring MLTCP”) for Medicaid beneficiaries.  In connection with the RiverSpring MLTCP, RIVERSPRING arranges for health and long-term care services and is reimbursed by Medicaid through per-member payments on a monthly basis (“Capitation Payments”).

The settlement resolves allegations that RIVERSPRING submitted false claims to Medicaid for months during which RIVERSPRING failed to provide, or failed to adequately document, certain long-term care services to RiverSpring MLTCP members as obligated by the applicable contract between RIVERSPRING and the New York State Department of Health (“DOH”).

Under the terms of the settlement approved today by U.S. District Judge P. Kevin Castel, RIVERSPRING must pay a total sum of $10,159,130.95, with $4,063,652.38 paid to the United States and the remaining amount paid to the State of New York.  As part of the settlement, RIVERSPRING admits that it either did not provide RiverSpring MLTCP members with qualifying services as required by the applicable contract with DOH or did not adequately maintain documentation of the provision of such services during some or all of their enrollment in the RiverSpring MLTCP.  As a result, RIVERSPRING obtained Medicaid payments to which it was not entitled.

U.S. Attorney Damian Williams said: “RiverSpring collected millions of dollars in Medicaid payments to provide long-term care services as part of its managed care plan, but in many cases either failed to deliver these services or failed to maintain adequate documentation showing that it did so.  This Office is committed to holding recipients of government health care funds accountable when they fail to provide the care and services the government pays them to provide.”

HHS-OIG Special Agent in Charge Naomi Gruchacz said: “As a part of this settlement, the defendants acknowledged that they obtained funds from the Medicaid program to which they were not entitled.  Individuals and entities that participate in the federal health care system are required to obey the laws meant to preserve the integrity of program funds and the provision of appropriate, quality services to patients.”

As alleged in the Complaint filed in Manhattan federal court: 

RIVERSPRING administers a managed long-term care plan for Medicaid beneficiaries pursuant to applicable contracts with DOH (the “Contract”).  To be eligible for enrollment into a managed long-term care plan, a Medicaid beneficiary must, among other things, be assessed as needing at least one of the community-based long-term care services listed in the Contract (“Qualifying Services”) for more than 120 days from the effective date of enrollment.  These services include nursing services in the home, therapies in the home, home health aide services, personal care services in the home, and adult day health care.  In order to receive Capitation Payments from Medicaid for members of the RiverSpring MLTCP, RIVERSPRING was required to ensure that RiverSpring MLTCP members received Qualifying Services during their enrollment or otherwise remained appropriately enrolled in the RiverSpring MLTCP consistent with the Contract and DOH disenrollment practices.  In exchange for arranging and providing these services, RIVERSPRING received Capitation Payments averaging between $4,000 and $4,500 for each member.

As part of the settlement, RIVERSPRING admits, acknowledges, and accepts responsibility for the following conduct:

  • In many instances, RIVERSPRING either did not provide RiverSpring MLTCP members with Qualifying Services or did not adequately maintain documentation of the provision of such Qualifying Services during some or all of their enrollment in the RiverSpring MLTCP.  Nonetheless, RIVERSPRING received Capitation Payments to which it was not entitled for these RiverSpring MLTCP members for the months in question.
  • In many of these instances, RIVERSPRING collected Capitation Payments for RiverSpring MLTCP members despite the fact that RIVERSPRING either did not provide or did not maintain documentation reflecting the provision of Qualifying Services to these members for three or more consecutive months during their enrollment in the RiverSpring MLTCP.
  • In other instances, RIVERSPRING collected Capitation Payments for RiverSpring MLTCP members despite the fact that RIVERSPRING either did not provide or did not maintain documentation reflecting the provision of Qualifying Services to these members during the entirety of their enrollment in the RiverSpring MLTCP.

In connection with the filing of the lawsuit and settlement, the Government joined a private whistleblower lawsuit that had been filed under seal pursuant to the False Claims Act.

Mr. Williams thanked HHS-OIG for its assistance.  Mr. Williams also thanked the Medicaid Fraud Control Unit of the New York State Attorney General’s Office for its investigative efforts and work on the case.

California Man Arrested for Making Violent Threats Against North Carolinians

 

A Huntington Beach, California, man was arrested on federal charges relating to sending threats to individuals and knowingly making false bomb threats. Kevin Dunlow, age 62, is charged in a complaint unsealed in the U.S. District Court of the Eastern District of North Carolina following his arrest in California. He will have his initial appearance, and his detention hearing will be set at a later date.

“Hate-fueled, violent threats endanger the safety of individuals and entire communities,” said Attorney General Merrick B. Garland. “This defendant is accused of making explicit and detailed threats, ranging from making a bomb threat against the Wake County Sheriff’s Office, to threatening an elected official, to telling a Rabbi, ‘I am coming to the Temple to kill all the Jews and the children.’ The Justice Department will prosecute anyone who makes illegal threats motivated by antisemitism or bias of any kind.”

“We will not normalize violent threats in America, whether targeting law enforcement, elected officials, or average citizens,” said U.S. Attorney Michael F. Easley Jr for the Eastern District of North Carolina. “The complaint alleges the defendant made violent threats against people of faith, cops, and public servants. These cases will always receive our highest attention.”

According to the affidavit in support of the criminal complaint, Dunlow made numerous threats targeting multiple entities and individuals, including an elected official, members of law enforcement, and several synagogues located in North Carolina, while residing in California at the time the threats were made. On or about May 7, Dunlow allegedly stated, “Jews didn’t deserve to live. Jews didn’t deserve to be on this earth. I’m going to kill the Jews. I’m coming to the Temple to kill all the Jews and the children.”

In addition, Dunlow allegedly made a false bomb threat to the Wake County, North Carolina, Sheriff’s Office.

Dunlow is charged with illegally using any form of communication to send a threat to harm or kidnap another person intentionally, and he is charged with illegally knowingly making false reports about bombs. If convicted, Dunlow faces five years in prison for each charge. 

U.S. Attorney Michael Easley for the Eastern District of North Carolina made the announcement.

The FBI Charlotte Field Office is investigating the case, with assistance from the FBI Los Angeles Field Office and the Justice Department's National Security Division.

Assistant U.S. Attorney Gabriel Diaz for the Eastern District of North Carolina is prosecuting the case.

A criminal complaint is merely an accusation. All defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law. 

Attorney General James and DEC Interim Commissioner Mahar Sue Contractor for Illegal Construction Near Protected Wetlands on Long Island

 

Anthony Labriola and His Companies Destroyed Protected Wetland Buffer Area Near the Carlls River to Use as a Parking Lot and Storage Facility

New York Attorney General Letitia James and New York State Department of Environmental Conservation (DEC) Interim Commissioner Sean Mahar filed a lawsuit against Anthony Labriola and his two affiliate companies—ALAC Realty, LLC (ALAC Realty) and ALAC Contracting Corp. (ALAC Contracting)—for illegally building a storage lot to park heavy-duty construction vehicles and store equipment on a protected area along the Carlls River in West Babylon, Suffolk County. Labriola and his companies removed trees and other vegetation from, then graded, a designated “buffer area” adjacent to wetlands of the Carlls River, the fourth longest river on Long Island. These wetlands have DEC’s highest classification for the benefits they offer, including providing wildlife habitats, and flood control and protecting water quality on Long Island. 

Despite a years-long enforcement effort by DEC, Labriola and his companies have refused to remove equipment, restore the site, and pay outstanding penalties. Attorney General James and DEC are seeking to require Labriola to clean up the site, replant it with native vegetation, and for Labriola and his companies to pay at least $591,000 in combined civil penalties.

“New York’s freshwater wetlands are a valuable natural resource, particularly in highly developed areas like western Suffolk County, providing wildlife habitats, flood control, and water quality protection. It is important to protect their benefits for current residents and generations to come,” said Attorney General James. “Anthony Labriola and his companies blatantly violated our environmental laws and continued to evade enforcement efforts, but now we are going to make sure he restores what he has damaged. I want to thank DEC for their continued partnership in defending our natural resources.”

“Freshwater wetlands help protect water quality, provide habitats for wildlife, and promote community resiliency, among many other benefits, and illegal construction and removal of vegetation from regulated areas in and around wetlands can negatively impact the environment and communities long after the initial damage,” said DEC Interim Commissioner Sean Mahar. “DEC is working closely with Attorney General James to hold Anthony Labriola accountable for his illegal actions and require this contractor to restore damage to these wetlands, which are critical to the sustained protection of Long Island’s sole source aquifer.”

Freshwater wetlands throughout the state control flooding and provide valuable habitats for a diverse array of wildlife, among other benefits. To protect these wetlands and surrounding areas, the New York Freshwater Wetlands Act prohibits removing trees and vegetation, placing fill, or building commercial facilities on designated wetlands and protected adjacent “buffer areas” without a permit from DEC. 

New York’s wetlands are classified on a scale ranging from Class I wetlands, which provide the most environmental benefits, to Class IV wetlands, which provide the least. These benefits refer to the work wetlands do for the surrounding community, such as storing flood and storm surge water. The Carlls River wetlands are Class I wetlands, and particularly valuable to the Long Island environment because of their biological diversity and role in protecting Long Island’s sole source aquifer.

In February 2015, DEC issued a notice of violation to Labriola after discovering that he had illegally cleared trees and vegetation and built a parking lot on top of the protected Carlls River wetlands-adjacent buffer area on a property his company owns at 420 Falmouth Road in West Babylon. Despite DEC’s enforcement efforts and Labriola's agreement to remove the construction equipment from the protected area and revegetate it with native plantings, Labriola repeatedly failed to comply, and instead continued to use the area illegally as parking and storage for his construction business, ALAC Contracting. The DEC estimates that by storing his construction vehicles, equipment, and materials on the illegally utilized area, Labriola and his companies have to date saved nearly $150,000 that they would have had to pay to use commercial space in the vicinity.

Labriola(1)

   Site at 420 Falmouth Road in 2010, Before Illegal Construction       

Labriola(2)

Site at 420 Falmouth Road in 2024, After Illegal Construction

For years of violating the consent order with DEC, Attorney General James and DEC Interim Commissioner Mahar are seeking an injunction requiring Labriola and ALAC Realty to completely remove illegally stored vehicles and equipment, revegetate the wetland-adjacent area with native trees and other plantings as previously agreed, and pay civil penalties totaling no less than $371,000. The OAG and DEC also seek to compel ALAC Contracting to pay civil penalties of no less than $220,000 and to remove all of its vehicles and equipment from the regulated area covered by DEC’s consent order with Labriola and ALAC Realty. 

Attorney General James thanks DEC for their continued partnership in protecting New York’s natural resources.

The matter is being handled for DEC by Long Island Regional Attorney Craig Elgut, Regional Manager in the Bureau of Ecosystem Health Kevin Jennings, and Regional Enforcement Coordinator Chris Spies.

Permits Filed For 2259 Crotona Avenue In Crotona, The Bronx

 

Permits have been filed for a seven-story residential building at 2259 Crotona Avenue in Crotona, The Bronx. Located between East 183rd Street and Grote Street, the lot is near the West Farms Square-East Tremont Avenue subway station, serviced by the 2 and 5 trains. Andrea Gjini under the 781-783 Elsmere Place is listed as the owner behind the applications.

The proposed 77-foot-tall development will yield 17,014 square feet designated for residential space. The building will have 29 residences, most likely rentals based on the average unit scope of 586 square feet. The masonry-based structure will also have a penthouse, nine open parking spaces, and three enclosed parking spaces.

John Backos of Sierra Construction NY is listed as the architect of record.

Demolition permits will likely not be needed as the lot is vacant. An estimated completion date has not been announced.

Sunday, May 26, 2024

Garden Towers Affordable Senior Housing Development Completes In Morrisania, The Bronx

 

Garden Towers Exterior Detail: Developed by Foxy Management, in partnership with HANAC, Inc. and JLD Advisory LLC, Garden Towers includes two residential buildings – rising seven stories and eight stories – that together offer a total of 149 rental homes for low-income adults age 62 or older. (Credit: David Joshua Ford)

Garden Towers Exterior Detail: Developed by Foxy Management, in partnership with HANAC, Inc. and JLD Advisory LLC, Garden Towers includes two residential buildings – rising seven stories and eight stories – that together offer a total of 149 rental homes for low-income adults age 62 or older. (Credit: David Joshua Ford)

Garden Towers Apartments, a 149-unit affordable senior housing development, recently completed construction in MorrisaniaThe Bronx. The development, which is made up of two residential buildings located at 1323 Boston Road and 1332 Clinton Avenue, was designed by Newman Design Architects. It was developed by Foxy Management working in partnership with HANAC Inc and JLD Advisory LLC.

Garden Towers New York City: Lendlease served as general contractor for Garden Towers, an affordable senior housing community in the Bronx developed by Foxy Management, in partnership with HANAC, Inc. and JLD Advisory LLC. (Credit: David Joshua Ford)

Each building in the Garden Towers project was designed to meet Passive House standards and Enterprise Green Communities criteria. Efficiency-oriented features include electric MEP systems, upgraded insulation, and a rooftop solar array. The two buildings are connected by a glass greenhouse walkway and offer a variety of amenities, including multipurpose rooms and a social services suite. Thirty percent of all units have been reserved for homeless seniors, and all apartments have been designated as affordable to households earning at or below 50 percent of the area median income.

Garden Towers Greenhouse Walkway: Garden Towers’ two residential buildings are connected by a glass greenhouse that serves as both a walkway between the structures and focal point for residents and visitors. (Credit: David Joshua Ford)

“Lendlease has proven time and again to be the preeminent construction partner for our affordable housing projects. Garden Towers is a state-of-the-art, health-focused senior housing complex, completed on time and on budget thanks to the close collaboration between ownership and Lendlease,” said Jeff Fox, principal of Foxy Development.

New York City Council Votes on Laws to Improve Safety of Parking Garages

 

The New York City Council voted on legislation to improve parking garage safety and building integrity by requiring the Department of Buildings (DOB) to conduct a loadbearing capacity study of garages, increasing the frequency of inspections, and doubling the standard civil penalties for certain DOB-enforced violations. The Council passed today’s bill package to proactively identify and address structural vulnerabilities to prevent tragedies like last year’s parking garage collapse at 57 Ann Street in Lower Manhattan.

“Addressing structural safety issues in our city’s parking garages by keeping them in good repair can save lives and prevent future tragedies,” said Speaker Adrienne Adams. “These comprehensive solutions will result in more frequent inspections and prompt garage owners to quickly address any problems that are identified to keep people safe. I’m also proud to pass legislation today to increase transparency and oversight of the JFK International Airport redevelopment plan, which has a tremendous impact on surrounding communities in Southeast Queens. By requiring annual reporting on the $13 billion project and related community benefits, the Council and local community can be better informed about its progress. I thank my Council colleagues for their leadership and hard work on these important bills.”

Improving Parking Garage Safety and Building Integrity

On April 18, 2023, a parking garage located at 57 Ann Street in Lower Manhattan collapsed, resulting in the death of the garage manager, Willis Moore, and injuring five others. At the time of the collapse, there were various open violations for loose, defective, and cracked concrete throughout the building structure. Following the collapse, the Department of Buildings (DOB) inspected hundreds of garages across the city and issued multiple full and partial vacate orders. The Council’s bill package aims to address gaps in the safety of parking garages to prevent any future tragedies.

Introduction 135-A, would require DOB to conduct a loadbearing capacity study for parking garages. DOB would be required to assess factors of building integrity, such as the size, age, materials, and structural design of the parking structure. DOB would also be required to submit these findings and accompanying recommendations to the Mayor and the Council, and post them to its website as a report.

“The safety of our New Yorkers is a critical priority, and this bill is an important step in preventing future tragedies.” “By requiring a loadbearing capacity study for parking garages, our city will better identify structural issues before disaster strikes. This legislation is a proactive measure to bolster our infrastructure to make it safe, reliable, and capable of withstanding everyday use. Our commitment to rigorous inspections and oversight will save lives and build greater public confidence in our city’s facilities.”

Introduction 170-A, would double the standard civil penalties for certain DOB-enforced violations when issued to the owner of a parking structure to promote improved compliance that better maintains the safety of parking garages.

Introduction 170-A, is to serve as a key deterrent for parking structures across New York City. It will double all initial violations related to parking structures with the exception of sections 28-301.1 and 28-302.1; which had varying fees dependent on class and violation description. This is to create uniformity around parking structure violations and ensure the fees New York City have in place are a strong deterrent from mismanagement. With the passage of today’s bills we remember the Ann Street garage last April that resulted in the death of one worker, 59-year-old manager Willis Moore, and injured five more people. 

Introduction 231-A, would increase the frequency of parking structure inspections from a six-year inspection cycle, as mandated by Local Law 126 of 2021, to a four-year inspection cycle. It would also require that follow-up assessments be conducted within two years after a parking structure is deemed safe with repair or monitoring.

“Just over one year ago, we witnessed a parking structure collapse in the heart of the Financial District, claiming the life of one of our neighbors mere blocks away from City Hall,” . “In the wake of this tragedy, the city scrambled to inspect other parking structures, ultimately finding that dozens of other buildings had similar hazardous defects. It is the government’s responsibility to guarantee the integrity of the infrastructure that shapes our communities—including parking structures. Doing so keeps our neighbors safe, and the passage of Int. 231 will help us bolster New Yorkers’ sense of security and serve as a tangible step toward ensuring our city’s government is a proactive force to prevent future tragedies like that of 2023.”

DOHMH INSPECTOR REPORTS TO DOI GRATUITY BY MANHATTAN DELI OWNER SUBSEQUENT INVESTIGATION AND PROSECUTION RESULTS IN GUILTY PLEA BY DELI OWNER TODAY

 

Jocelyn E. Strauber, Commissioner of the New York City Department of Investigation (“DOI”), announced the arrest and guilty plea of a Manhattan deli owner on a charge of giving an unlawful gratuity by providing $400 in cash to a City Department of Health and Mental Hygiene (“DOHMH”) inspector and suggesting the inspector fail to appear at a court appearance concerning the 67 violations identified at the restaurant. The investigation was prompted by the DOHMH inspector who reported to DOI that she found cash in her bag following her inspection of the deli. The case is being prosecuted by the Office of Manhattan District Attorney Alvin L. Bragg Jr. 

HASSAN ALBORATI, 61, of Brooklyn N.Y., was charged with and pled guilty to Giving Unlawful Gratuities, a class A misdemeanor. According to the terms of the plea agreement, ALBORATI will forfeit $400 to the City and has been sentenced to a Conditional Discharge. Separately, DOHMH is expected to begin proceedings to revoke his restaurant license. 

DOI Commissioner Jocelyn E. Strauber said, “Giving cash to a City Department of Health and Mental Hygiene inspector with an intention to thereby evade the full impact of health violations is against the law. I thank the DOHMH inspector who immediately reported this attempt to improperly influence her with a cash payment and the Manhattan District Attorney’s Office for their commitment to maintain the integrity of City inspections.” 

Manhattan District Attorney Alvin L. Bragg Jr. said, “The Department of Health and Mental Hygiene’s sanitary inspections ensure New Yorkers are safe at restaurants throughout New York City. Hassan Alborati gave an unlawful gratuity by providing $400 in cash to a DOHMH inspector in an attempt to evade the enforcement of 67 violations his restaurant was facing. We will continue to root out fraud in Manhattan alongside our partners at DOI.”

DOHMH Commissioner, Dr. Ashwin Vasan said, “By ensuring that food is prepared in sanitary environments, inspectors play a critical role in keeping New Yorkers healthy. To be effective, they must be fair and honest. We applaud the integrity of this inspector who reported illegal behavior to the City Department of Investigation and upheld the standards that are expected of food service in New York City.”

According to the criminal complaint, on Friday, May 19, 2023, a DOHMH inspector conducted an inspection at Gardenia Deli on 8th Avenue in Manhattan. ALBORATI, the owner of the Deli, was present. The DOHMH inspector found 67 violations and instructed ALBORATI to obtain the services of an exterminator and to seal holes identified as potential access points for vermin. The DOHMH inspector also told ALBORATI that due to the number of violations, his deli would be re-inspected within seven days. At the conclusion of the inspection, the DOHMH inspector asked ALBORATI if she could use the restroom. She left her work bag on top of a freezer chest while she did so, and later that day, she found a white unmarked envelope with $400 inside her work bag. The inspector called ALBORATI that day and he confirmed that he placed the $400 in the bag. On June 14, 2023, during a recorded call, the DOHMH inspector spoke to ALBORATI who again confirmed that he had provided the $400 to the DOHMH inspector. When asked what ALBORATI wanted in exchange for the cash, ALBORATI responded that not showing up in court would be good for the deli because the judge could reduce the impact of the violations. With the 67 violations, ALBORATI faced a potential C grade if the violations were not corrected upon reinspection.

DOI Commissioner Strauber thanked Manhattan District Attorney Alvin L. Bragg Jr., and his staff for the prosecution of this matter, which is being handled by Assistant District Attorney Jaime HickeyMendoza. Commissioner Strauber also thanked DOHMH Commissioner Dr. Ashwin Vasan and his staff for their assistance and cooperation.

Florida Businessman Daniel Hurt to Pay Over $27 Million for Medicare Fraud in Connection with Cancer Genomic Tests

 

Daniel Hurt, who owned and/or operated Fountain Health Services LLC, Verify Health, Landmark Diagnostics LLC, First Choice Laboratory LLC and Sonoran Desert Pathology Associates LLC, has agreed to pay over $27 million to resolve allegations that he and his companies conspired with others to violate the False Claims Act (FCA) by submitting false claims to, and receiving payments from, Medicare for cancer genomic (CGx) tests that were not medically necessary and were procured through illegal kickbacks. Hurt, Fountain Health, Verify Health, Landmark Diagnostics, First Choice and Sonoran Desert Pathology also agreed to be excluded by the Department of the Health and Human Services Office of Inspector General (HHS-OIG) from Medicare, Medicaid and all other Federal health care programs. Hurt previously pleaded guilty to criminal healthcare fraud for these offenses. The civil settlement is based on Hurt’s ability to pay.

The United States alleged that Hurt, his companies and others conspired to knowingly submit false claims for CGx tests that were not medically necessary to treat or diagnose a condition, and that Hurt received and paid kickbacks in exchange for Medicare referrals, in violation of the Anti-Kickback Statute (AKS). In particular, the United States alleged that, from January 2019 to November 2021, Hurt conspired with telemarketing agents to solicit Medicare beneficiaries for “free” CGx tests; with telemedicine providers to “prescribe” CGx tests that were not medically necessary; with reference laboratories to conduct the CGx tests and with billing laboratories and a hospital to submit claims for payment to the Centers for Medicare and Medicaid Services.

“We will not tolerate those who prey on older Americans to defraud Medicare,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “As this settlement reflects, we will use our available resources to protect federal health care programs and the beneficiaries they serve.”  

“Unnecessary medical services and false claims for medical services threaten patients and our public health programs,” said U.S. Attorney Roger B. Handberg for the Middle District of Florida. “This civil settlement demonstrates our commitment to protecting patients from unnecessary testing and our healthcare institutions from fraudulent billing.”

“Our office is committed to pursuing those who threaten our government healthcare programs by submitting false claims for medically unnecessary services that are tainted by unlawful payments to marketers,” said U.S. Attorney Markenzy Lapointe for the Southern District of Florida. “As these schemes become more complex and cross district lines, we will continue to work and coordinate with our law enforcement partners and other districts to ensure vigorous enforcement of the law.” 

“Medicare and Medicaid are two vitally important health care programs that provide critical services to millions of Americans,” said U.S. Attorney Philip R. Sellinger for the District of New Jersey. “Schemes that seek to siphon money from these programs with unnecessary medical tests are especially egregious. We will do everything we can to protect the public and the services they need, and to hold accountable those who try to bilk the system.”

“Submitting false claims for medically unnecessary services to Medicare and Medicaid jeopardizes the integrity of vital health care programs, and we, along with our law enforcement partners, will continue to make sure those who attempt to do so are held accountable,” stated Deputy Inspector General of Investigations Christian J. Schrank of HHS-OIG. “This substantial settlement underscores our steadfast dedication to safeguarding federal health care programs.”

This settlement includes the resolution of allegations brought in three cases filed under the qui tam or whistleblower provisions of the FCA, including an action filed by Robert Gerstein, a minority owner of Sonoran Desert Pathology, where he worked for Hurt, running the billing operations for CGx tests. Under the FCA, private parties can file an action on behalf of the United States and receive a portion of any recovery. Under today’s resolution, Relator Gerstein will receive up to $4.7 million or 17% of the government’s recovery.

The resolution obtained in this matter was the result of a coordinated effort between the Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section, Corporate/Financial Litigation Section, U.S. Attorney’s Office for the Middle District of Florida, U.S. Attorney’s Office for the Southern District of Florida and U.S. Attorney’s Office for the District of New Jersey, with assistance from HHS-OIG.

The investigation and resolution of this matter illustrates the government’s emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse and mismanagement, can be reported to the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477).

The matter was handled by Trial Attorney Samson Asiyanbi of the Fraud Section, Trial Attorneys Augustus Curtis and Andrew Warner of the Corporate/Financial Litigation Section, Assistant U.S. Attorneys Jeremy Bloor for the Middle District of Florida, Rosaline Chan for the Southern District of Florida and David Dauenheimer for the District of New Jersey and the Miami Regional Office of HHS-OIG.

The claims resolved by the settlement are allegations only and there has been no determination of liability.